Revisiting the Numbers: Update on COVID-19

You. All right? So it's been a little bit since we've done a video on the numbers, mainly because over the last three to four to five weeks there have not been any major changes to report as far as the daily fluctuations in the numbers. However, as of this past week, I do feel like there have been some changes that are worthwhile talking about, hence I'm doing this video. A couple of basic data points to note before we start talking about the numbers. The first thing is, is incubation of the SARS CoV2 is anywhere from one to three days. Most people get symptoms within seven days and people when they die from it, typically most are going to die within 19 days. I know there's variation with that. Incubation might be as long as 14 days. But for the vast majority of people after exposure, within seven days you'll have symptoms and within 19 days you'll die if you're going to be one of those numbers. So when I look at these trends, you don't necessarily look at day to day fluctuations like the stock market. You want to look at the general trends. And so that's the reason I've held off doing any videos because there have not been any major trends. So what I want to do is go through numbers, go through countries, go through areas in the world and then come in the United States and go through states and just talk about what I'm seeing. Some thoughts on explanation numbers and what that means for us today and going forward in school in the fall, what that might mean for us in the United States. So I do want to start with China just because. Look at this. China daily new cases. China has not had any cases in, wow. In months. And if you look at daily deaths, you know, China has not had deaths in months. The reason I'm showing this to you from the Worldometer, which is where this is from, is mainly to. To show a point that the data is only good as the input. If there's no data being input and it's not being input accurately, that's kind of useless. Point of this is that in the United States we're doing things a little bit haphazardly. Some states are reporting different than other states. Some states, if you have a positive test, they'll do a repeat test to verify that you have the disease. And if it's positive, you'll have two positive tests. Some states are doing presumptive positives where if they test someone the positive, everybody in the house is, the family is considered positive. So there's a lot of disparity in the numbers. So point of this is just to visually so hey data. And it's kind of what you get. I think overall numbers in the United States are reliable and dependable. But until we kind of figure out a unified way to report the data, we're going to have some ongoing questions and controversies about it. Now Italy, what we saw was Italy was the first. The coronavirus started in China, came through Europe, started in Italy. So we saw was by the time they figured out what's going on, Italy had already spread rapidly. So we saw within a few, within a month, from July 27 to March 27, you had to peak within four weeks. So basically that means this hit Italy and went throughout the whole country basically. But the good thing is since May, June, July, almost three months, cases have been down. So this is probably run through Italy mostly. They're probably not going to have a peak come fall, winter. Their death rate mirrors that of their, their infection rate, which is kind of unique as we go through different countries and we talk about the United States. But the basic gist is this is probably going through Italy. They're probably not going to see a repeat surge in this and it's kind of going through their country. So I'm using this as the paradigm for that. Now Sweden's interesting in that Sweden never really fully shut down. They only limited access to the elderly, the high risk people. They kept out of the, out of exposure. And so with their cases, there was, you know, smoldering the cases. They were having anywhere from 400 to 500 cases a day. They had a gentle peak in the summertime and it's come down. The interesting thing with Sweden is the deaths mirror what we saw in Italy. So what they did is they protected the high risk, so the high risk people got exposed. Got it. And we see this gentle trend that looks just like Italian trend. Even though they approached it differently, they only protected basically the high risk people. Again, you know, cases versus deaths. I want to keep that in mind. Sweden is the paradigm for kind of letting it ride, but not letting the elderly be exposed wearing masks and places that are hot, really dense and living up to the people. And fortunately, unfortunately, Sweden did not have a high penetration of penetrance of mask wearing like other countries have had. So the United Kingdom, the United Kingdom, we trailed the United Kingdom by about four to six weeks this whole time. So when I was tracking back in March, April, May and doing these videos back then, I was talking about how the UK was a paradigm for the United States. What's happening first there is probably going to happen to us. And you see their, their track. They tried to initially do the Sweden thing, keep things open, but they very quickly change their minds and start masking social distancing, etc. Closing things down. And yet their, their curve looks mostly like the Italian curve as well. They're. What was that? I'm sorry, I was going the wrong direction. Sorry about that. They're. This is their case curve and that was their death curve. Now their cases are interesting in that they didn't have this really big peak like they had in Italy. It was this gentle smoldering coming down. But they did, their deaths did look very similar, suggesting that the elderly, sick, high risk people got it. It's kind of burning through the population and still smoldering there. But we're not seeing, with things easing off, we're not seeing a huge uptick in the cases in the United Kingdom. And by the way, they are behind us by about four to six weeks. I'm sorry, they're ahead of us by four to six weeks. Now Spain was a wholly different city, wholly different case. I'm sorry. They got hit pretty hard, things puckered off, but now cases are going back up again. I'm not quite sure how to explain the case uptick. If you look at the numbers of about 2, 2 to, you know, 3,000 cases a day, much less than their 8,000 a day. But I think the ultimate curve you want to look at is not the case, it's the deaths. And when we see the deaths are, that looks like the Italian curve and it's puckered out. So what that means in Spain is even though more people are getting it now, they're not dying from it either because the high risk people are not going out and being exposed, which actually is the case, mask wearing is being instituted. But also a lot of the vulnerable have already passed away from this illness, unfortunately. So even though they're seeing this uptick right here, a significant uptick from, you know, 300, 400 cases a day when it leveled off to, you know, just about a tenfold increase, you're seeing absolutely no increase in deaths. This is important because the question is, will we see that this here in the United States as things pick up, that the debt, the case of incidence of deaths are not picking up? Well, no. Let's see. So United States. Now one thing about the United States, we have to remember as the United States is one country, but it's not a country, it's 50 semi autonomous zones that have Self governance that share a federal form of government. What that means is, is that Virginia is governed differently. We're a commonwealth. We're governed differently than California, Florida, Louisiana has a parish system based on the French history, their history being a French colony initially. And so each, each state is totally different. So we look at this curve in the United States and we see an uptick in cases. The big thing becomes, you know, what's the rest of country look like? What's the state you look, you live in look like? Now, if you look at the actual daily cases, you know, 32,000, 28,000, now we're seeing 70, 60, so we've seen about doubling. We'll round up a tripling of the cases. So the question in my mind is what we saw back in April was seeing roughly a tripling the cases in July. Okay, how about deaths? Are we seeing a tripling in the instance of deaths? And the answer is no, we're not. So actually, the number of Deaths from about 2400 back in April came down to about 600 and now has gone up to about 1412 to 400, 1400. So we're seeing a doubling in deaths from our low, but still the overall deaths are much lower than they were before. Even though we're actually seeing now an uptick in cases. We're having way more cases now than we have in the beginning, but not more deaths. So the point here is, though, cases are going up, deaths actually are staying down. And this is exactly what we want to see when we see more people get it, which is what that graph depicts, but not more people dying from it. So the question is, what does the state where you live look like? Does it reflect this, this increased incidence, but lower relative death rate? I don't know. Let's go through some states and treat them like countries and compare with other countries. And that's what I'm going to do. So let's start with New York. New York is our Italy, basically. As the virus came from China to Europe, it mutated into a different strain that spread more easily but was also less lethal. The front came from Europe to the east coast of New York and spread very quickly. One of the things that New York did, city property did not do when cases were initially there, they actually were sending some of the older people back to nursing homes. So they're actually facilitating the spread among the elderly. So you'd expect to see a high death rate on the front end of things. They also did not shut down the subway system for quite some time. So it was literally just spreading throughout the major population center of New York and the surrounding area. So it pretty much, it was as if they didn't do a whole lot just because of the way the dynamics of one of the biggest population centers in the world. And that's not a political statement. It's just New York is a very special city. There's only one New York, there's only one London, you know, so it just was, you know, just the way it was. But then the question becomes deaths. And this is the important thing. New York has worked. New York has passed this pretty much. If you look at this, they had a ton of deaths in the front end and they're having a few, just a trickle. Now. If you look at the deaths per their cases, the cases have been pretty stable, but the deaths are pretty, pretty low. So some of the data suggests that up to 50% people in certain boroughs in New York City proper actually have already had this. So New York may already have hit their herd immunity. Gonna be hard to know. They were having it raging in the wintertime when people were fall, when people aren't quite out all the time. Now people are out and about and it's not really picking up. It's relative out and about right now because of social distancing. California, this is so California. It was interesting because on the front end of things, they did not have an uptick in cases. Different state, different geographic location, different environment. You know, back in March, time frame, you know, New York is a pretty. I'm sorry, California is a pretty moderate environment, you know, so it wasn't until summertime came around after the 4th of July, you start to see the cases in New York go up. And if you look at the relative increase, you're looking at 1600 cases a day to 8,000, 10,000. So there may be an eight to tenfold increase in cases. Okay, so the bigger question is not cases, but it's deaths. And here we see this, deaths have been relatively stable. And this is quite intriguing. 82 deaths, 98 deaths a day now maybe 135. So not quite a doubling. You know, if you want to do the math, 92 to 120. So maybe a 50, 50% increase from that time frame, while the numbers are increasing by magnitudes from, you know, again, tenfold. So we're seeing is a rapid, significant, huge increase in cases. But in relationship to the increase in cases, a diminution or a decrease in deaths. So even though death absolutely is up a little bit in relation to the cases, it's Low. And this is exactly what we want to see. We want to see people getting it and not dying from it, relatively speaking. The other thing about the New York is about California sea is their curve has been pretty flat. People are going to get this. So if they'd been like New York and be on the front end, they would look like New York now. And that's where, you know, the question at the beginning of this was we do the swing thing, do we get through the pain quickly and work through it or do we kind of slow the process down? So this is a great, great graph of how we've slowed this whole process of spread down so that our hospitals could adjust, we could flatten the curve. We would not have our system overrun. We could develop new therapies. And actually this has worked because as more people are getting it, more people aren't really now a lot more people are dying. So actually the time we bought to figure out new management, new therapies, dexamethasone, iferon beta, all these different things, how we can lie people, how not to intubate them. It's actually made a difference in how people are being treated and people are doing better. So let's go to a different state. Let's go to Florida. Okay. Now, Florida is an interesting case study because it's the oldest as far as age of a population has the oldest, biggest group of old people in the country. Yet on the front end of this, not a lot of people are getting it. You know, it wasn't until summertime came around and it got hot and everybody goes inside their air conditioning houses, which is, it was my personal experience when I lived down there in the summertime, everybody pretty much hid indoors and you're seeing the cases explode. So again, let's do the little kind of basic math. You know, 1400 cases a day, now we're seeing 11,000. So yeah, eight, nine fold. Forgive me if my math is not 100% accurate. I'm kind of winging it. But roughly eight to nine fold increase in the cases. What do the deaths look like? Okay, we do see an increase in the deaths, but relatively 61 cases to, you know, 256. So we're seeing a three to four fold increase in deaths. So we're not seeing the same level of increase in deaths as we are in cases. And this is exactly one of you want to see why is that? Well, it's because the older people are being kept away from the young people so they don't get sick. Is it because of the New therapies we have is it because now we know more about, we know more about face mask wearing and social distancing. Kind of hard to know. This was not the experience of Italy or New York as far as on the front end, but now we're kind of a lot more being able to use their experience to minimize deaths in these areas that are actually having a slow exposure. And this is what we expect to see ultimately as we get back out and get exposures. People have to get it. This curve right here has to ultimately as far as cases has to the area in the curve for New York and for Sweden and for Italy has to ultimately all be the same. Whether that you crunch it into one month or two months, or if you spread it out over half a year, three quarters a year ultimately, or all the lines as far as their volume have to equal the same relative to the population. Texas very similar to Florida. Not a whole lot in the front end. Now we're seeing a lot of cases in the back end. Do the little thing, you know, 1400 cases a day. Now we're seeing, you know, 9,000, 10,000. So you know, maybe an eight fold increase in cases. What's the relative increase in deaths? You know, if you look at, you know, 56, 30, 56 a day. So now about four fold increase in deaths. So you're seeing again the death incidence is increasing, but relatively cases, it's a slower increase. Tenfold increase in cases, four fold increase in deaths, it gives you six fold. Why aren't those six fold? Why aren't we seeing a tenfold increase in cases, tenfold increase in deaths? Because we are mask and we are wearing social distancing. We have new therapies that if you get sick we can treat you early. We can have preventive things like the vitamin D and the NAC and the things we've been talking about for three or four months that tons of people are taking now. We have a new way to treat you if your oxygen level is low, we've got new biologics. So much has changed in the six months that's allow us to treat this better. Virginia, Virginia is a very moderate environment. That's where I live. If you look at the cases of Virginia, our system was never overrun medically. We did a pretty good job of keeping our systems going, looking at 9, 800, 900 cases a day. And now we're having, you know, not here. So really if you look at the number of cases, we do have some spikes here. But the actual cases, you know, had A little dip, you know, but it hasn't really been anything kind of crazy. If you look at the deaths again, you know, it was, it looks like there's more deaths. If you kind of look at this whole general feel for this curve, there's more on the front end, you know, less on this side, a little peak here. But ultimately we're not seeing a huge amount of fluctuation between cases and deaths. And again, if you look at this curve for Virginia, we're just spreading things out. And that's what flatten the curve. Does it flattens it out? You know, the expectation is, you know, the flatter you make it, the longer it takes to play out. If you peak on the front end like New York, it burns out quickly. If you do like California slow it out, it's gonna take longer. We're kind of in between the two of those where that's here it's kind of festering. But no crazy uptick in deaths. And that's the most important data point is not who gets this but who dies from this. Because half of all people who get this have no symptoms. If you're less than if you're a kid or a young adult, you get this. 80% of people have no symptoms. So the reality is we have to get this to save or protect the older. Now let's look at a couple other states that are different. More like more extreme weather in the wintertime and more modern summertime. Jersey, okay, New Jersey looks very much like New York in their, in their instance and their death very much like New York as well. So it probably went through Jersey very similar to as it went through New York. If you look at a moderate state like North Carolina, well, their cases in the front were kind of low. It looks like a hybrid between like Texas and California and Florida, but cases kind of turning up is almost in the line. You see like almost a nice line kind of coming up here. But then the question is, do we see, you know, if you're having foreign cases a day now we're seeing 2,000, which is roughly a five fold increase in cases. Are we seeing a five fold increase deaths? The answer is, I mean, it's roughly, I mean maybe a general gentle incline right here. Roughly the same. So again, more people are getting it and not more people in North Carolina are dying from it. Which is exactly what we want to see. Young, healthy people to get this. We want low risk people to get it. We want older, sicker people not to get it. To be protected, like my parents, like my mother and father in law like other people I know. And you want to prevent them from getting it. Massachusetts, Interesting. Their cases will peak. They did a little more gentle on the front end of things people don't talk about. Boston's a big metropolitan center. But you look at the daily cases that's come down Dale, it's kind of come up and come down and it looks more like the New York curb. Interesting. There were some homeless shelters in the Boston area. They're having on the front end 25, 30, 40% of the of people. They're already having this back in March ish timeframe. So this curve for Massachusetts, which is actually very modern, beautiful this time of year. People are out doing stuff. I have some patients that are actually I was doing video calls with this past week. People are doing their part, wearing their masks. We're not seeing crazy upticks. So Louisiana, another moderate stay in the front end peak came down. Now it's going back up on cases. But if you look at the deaths, it's kind of sort of mirrors the cases for them. I think the point is that we're not seeing a huge uptick with deaths with the cases going up, which is what you'd expect if the high risk people are being protected. If people are social distancing and wearing masks, which does not 100% prevent you from getting this, it just decreases the amount of virus you get exposed to. So you're degree of illness is not quite as bad. There's some interesting studies looking at mask wearing. You still get antibodies but you just don't get as sick, you know. So that's kind of my summary review. I know the numbers are being reported on daily basis, which makes things a little difficult because you know, you have a spike on Monday and a spike on Wednesday and spike on Friday. You only support the spikes. All you hear about is the spikes. So hopefully this gives people a little better view what's going on. I think my point is this is what we expected. If you flatten the curve in New York, you know, if you flatten this curve, the result is you lengthen it. So if you take the New York. We're basically the New York curve and we're. Let me find Virginia. Virginia. We're turning into the. This is the Virginia curve. So we're basically just going. We're just prolonging the process. We're lowering the total amounts and prolonging the process. Probably we'll see this continuing once school starts and kids start going back in some areas and the Richmond area, it Depends on what school you go to. But enough kids will be going out that will probably see a little spike in the fall. People should not be alarmed. It's just part of this whole thing. Until we get a vaccine, we need to be vigilant or until this burns out, whichever comes first. And it looks like in some parts of the country, like New York, it may have already burned out in some other northeastern states and other places like Texas and California and Florida did a good job of stopping the spread on the front end, but now they're on the back end having to deal with that, what that looks like. But overall, even though more people are getting it, relatively more people are not dying from as a percentage of those have been infected. So if this was helpful, please share it with friends. I've also I've learned that if you don't click on like it, if you don't share it, if you don't comment on it, it actually on the algorithms for social media, it's not really spread. So if this is helpful, please like it, please hit the little bell thing, please add a comment and that will just help disseminate this information to more people. Y' all take care and we'll talk to you soon.